Most Relevant Information
Provider Data
| NPI Number: | 1003586041 |
| Provider Name: | JETHRO DAVIS |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 09/20/2021 |
| Last Updated: | 09/20/2021 |
Provider Practice Location
6910 S HIGHLAND DR STE 1
COTTONWOOD HEIGHTS
UT
841213061
Practice Location Phone/Fax
| Phone: | 8019354171 |
| Fax: |
Provider Mailing Location
515 S 700 E STE 2A
SALT LAKE CITY
UT
841022855
Provider Mailing Phone/Fax
| Phone: | 8019354171 |
| Fax: |